Family Practice Advance Access published online on February 5, 2007
Family Practice, doi:10.1093/fampra/cmm004
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GPs' strategies in intercultural clinical encounters
a Department of Family Medicine, McGill University and St Mary's Hospital, Montreal, Quebec, Canada
b Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital
c Centre de Recherche et Formation, CSSS de la Montagme, Montréal
d Department of Community Medicine, Geneva University Hospitals, Geneva, Switzerland
e Département de médecine sociale et préventive, Faculté de Médecine, Université de Montréal
Correspondence to Ellen Rosenberg, Department of Family Medicine, McGill University, 515 Pine Avenue West, Montreal, Quebec H2W 1S4, Canada; Email: ellen.rosenberg{at}mcgill.ca.
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Abstract |
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Background. In North America and Europe, patients and physicians are increasingly likely to come from non-Western cultural backgrounds. The expectations of these patients may not match those of physicians.
Objective. To identify strategies used by GPs with patients from cultures other than their own.
Methods. We conducted a qualitative inductive study based on 25 semi-structured interviews with family physicians practising in Montreal, Canada. We elicited physicians' strategies when dealing with patients from a cultural background different from their own. We began by asking physicians to describe an encounter they found difficult and one they found easy.
Results. Physicians reported three types of strategies: (i) insistence on patient adaptation to local beliefs and behaviours; (ii) physician adaptation to what he or she assumed patients wanted; and (iii) negotiation of a mutually acceptable plan. Individual physicians did not adopt the same strategy in all situations. Their choice of strategy depended on the topic. When dealing with issues they felt deeply about, such as the autonomy of women, many physicians insisted on patient adaptation. Physicians used a patient-centred model of care, but had no framework to elicit information about patients' culture.
Conclusions. A patient-centred model of care enables physicians to consult effectively despite a wide range of cultural differences between themselves and their patients. However, their lack of a conceptual framework for addressing cultural difference prevents systematic data collection and consideration of challenges to respect for individual autonomy. Physician training should include the provision of an explicit conceptual framework for approaching patients from a different culture.
Keywords. Cultural diversity, ethnicity, migration and immigration, physician–patient relations.